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David Gerrard FACSP Dunedin School of Medicine University of Otago NEW ZEALAND

16th FINA World Sports Medicine Congress MANCHESTER 2008 “CHILDREN IN AQUATIC SPORT: a shared clinical responsibility”. David Gerrard FACSP Dunedin School of Medicine University of Otago NEW ZEALAND. OVERVIEW. EXERCISE AND HEALTH ETHICAL DUTY OF CARE TRAINING OVERLOAD

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David Gerrard FACSP Dunedin School of Medicine University of Otago NEW ZEALAND

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  1. 16th FINA World Sports Medicine CongressMANCHESTER 2008“CHILDREN IN AQUATIC SPORT: a shared clinical responsibility” David Gerrard FACSP Dunedin School of Medicine University of Otago NEW ZEALAND

  2. OVERVIEW EXERCISE AND HEALTH ETHICAL DUTY OF CARE TRAINING OVERLOAD GENERAL MEDICAL PROBLEMS MUSCULOSKELETAL DEVELOPMENT ORTHOPAEDIC INJURY

  3. EXERCISE & HEALTH Active lifestyle for children Neuro/musculo/skeletal development Socialisation Skill acquisition Diseases of “stasis” Childhood obesity Type 2 diabetes Legacy in adulthood…

  4. AQUATIC SPORT CHILDHOOD DEVELOPMENT COORDINATION RESPIRATORY BENEFITS “NON-ASTHMAGENIC” NON-WEIGHT BEARING STRENGTH WATER SAFETY

  5. TRAINING & HEALTH OVERTRAINING “STALENESS” FAILING ADAPTATION OVERLOAD OVERTRAINING SYNDROME

  6. Overreaching, Overtraining,Overexertion: EFFECTS ON PHYSICAL PERFORMANCE

  7. “MALADAPTATION” Exertion : overexertion Reaching : overreaching Training : overtraining Load : overload Work : overwork Use : overuse

  8. Pressures on Childrenin Sport Social Physical Emotional

  9. A DUTY OF CARE BIOETHICAL GUIDELINES COMMON PRINCIPLES INFORMED CONSENT AUTONOMY NON-MALIFICENCE COACH/PARENT/PHYSICIAN ADMINSTRATOR

  10. RECOMMENDATION “That the rights of the young swimmer ought to recognise age, competence and sex.”

  11. RECOMMENDATION “That those responsible for the care of the young swimmer respect professional boundaries.”

  12. EXISTING ETHICAL CODES

  13. OVERVIEW “That special consideration be given to the social, emotional and physical pressures on children engaged in aquatic sport.”

  14. GENERAL MEDICAL ISSUES CHRONIC VIRAL INFECTION The EARS NOSE & THROAT ASTHMA The SKIN CHRONIC FATIGUE ANAEMIA USE OF MEDICATION

  15. “INAPROPRIATE LETHARGY” Diagnosis of exclusion in young athlete: Infectious (viral) Pyschological (psycho-social) Metabolic Nutritional

  16. CHRONIC VIRAL INFECTION Eg. Infectious mononucleosis EBV (Epstein-Barr) Undulating clinical course Chronic fatigue/mood change Serological markers Convalescence Therapy Clear guidelines to coach/parents

  17. ANAEMIA Typically females Dietary intake of Fe Lethargy & pallor Serological markers of iron deficiency “Informed” therapy Sound nutritional advice

  18. Paediatric sports trauma “The immature musculoskeletal system is vulnerable to excessive physical loading and repetitious overuse…”

  19. “Avoid doing too much,too soon, too fast,too often - before it’s too late.”N. Mafulli MD.

  20. MUSCULOSKELETAL DEVELOPMENT Bone and soft tissue Asynchronous growth Sites of active growth Potential for stress Overuse trauma

  21. BONE AND SOFT TISSUE Essential stimuli Weight-bearing & NWB A menu of skills Repetitive stressors

  22. ACTIVE GROWTH SITES Epiphyseal plates Articular cartilage Apophyses Vulnerability to overuse

  23. OVERUSE INJURIESinSWIMMING

  24. The SHOULDER in SWIMMING Glenohumeral articulation Multiaxial Functional stability Overuse potential Rotator cuff Impingement

  25. ROTATOR CUFF “SWIMMER’S SHOULDER”

  26. “SWIMMER’S SHOULDER” Mechanism of pathology Subacromial impingement Stroke mechanics Muscle “imbalance” Early recognition

  27. LOW BACK PAIN Repetitive hyperextension Focal pain Exclude bone fatigue Gymnastics, dance, volleyball,tennis, cricket fast bowling, butterfly swimming

  28. “BREASTROKER’S KNEE” Medial knee pain Focal site Diagnosis of exclusion Mechanism of “kick” Valgus stress Torque “Egg-Beater” kick Water polo & synchro

  29. “BREASTROKER’S KNEE” “Pes anserinus” Insertions of: Sartorius Gracilis Semitendinosis Focal area Proximal tibia

  30. PRINCIPLES of MANAGEMENT PREVENTION Coaches must recognise the risk for specific injuries in aquatic sport.

  31. PRINCIPLES ofMANAGEMENT 2. AWARENESS The unique characteristics of the immature musculoskeletal system & response to the biomechanical stress of aquatic sport.

  32. PRINCIPLES of MANAGEMENT 3. DIAGNOSIS Emphasis on the accurate diagnosis of musculoskeletal injuries in children.

  33. SUMMARY The wellbeing of the child athlete must never be compromised by inappropriate sports participation or training.

  34. CHILDREN A precious resource…

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